Fillable TASFA (Texas Application for State Financial Aid) Check (Collin County Community College District)

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TASFA (Texas Application for State Financial Aid) Check (Collin County Community College District)

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The TASFA (Texas Application for State Financial Aid) Check (Collin County Community College District) form is 7 pages long and contains:

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  • 24 check-boxes
  • 269 other fields

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BROWSE COLLIN COUNTY COMMUNITY COLLEGE DISTRICT FORMS

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TASFA (Texas Application for State Financial Aid)
Check list – Dependent Students
Name: ______________________________CWID: __________________
Texas Application for State Financial Aid Application
Check to be sure ALL spaces are filled in
Application must be signed and dated by both student and 1 parent
SB1528 Statement Form
Dependent Verification
Check to be sure ALL spaces are filled in
Application must be signed and dated by both student and 1 parent
Student Tax Return Transcript or Tax Return, if filed, or W-2’s, or a detailed
statement of income earned and support provided to student/family
Parent Tax Return Transcript or Tax Return, if filed, or W-2’s, or a detailed
statement of income earned and support provided to student/family
If male, student must register for Selective Service
Must provide a copy of registration card
If male is under 18, provide the Selective Service Statement
HS Transcript (HSGEDV)
Internal USE:
SGASTDN (Check Residency)
TASFA students are coded as J or K (Print SGASTDN)
If coded anything else, notify student we cannot award them until
Admissions notes they are eligible for SB1528 status.
Office use only:
Aid Year:______ Campus:______ Date:__________ RRAAREQ Code: SB1528 Status Code:_______ Initials:_______
The Texas Application for State Financial Aid (TASFA) is used to collect information to help determine eligibility for state (or institutional) financial aid
programs that are administered by institutions of higher education in the state of Texas. Students that are classified as a Texas Resident who cannot apply
for federal financial aid using the Free Application for Federal Student Aid (FAFSA) are encouraged to complete the TASFA. To review the FAFSA filing
requirements, visit www.fafsa.ed.gov or visit the financial aid office at the institution you plan to attend for the 2019-20 award year. Please note that
Texas residency can only be determined by the institution that you plan to attend. This application cannot be used to determine your state residency
status or final eligibility for state aid.
To complete this application, each item within the applicable sections must be answered. For clarification on specific items, please reference the TASFA
Notes. If you have further questions, contact the financial aid office at your institution.
The Texas state priority deadline for many institutions of higher education is January 15, 2019 for the 2019-20 award year. It is recommended that
applicants complete and submit this application and any other required documentation to the financial aid office prior to the state priority deadline date.
-
STEP ONE: STUDENT INFORMATION (See Notes for questions 5-6)
1. Last Name
2. First Name
3. M.I.
4. Date of Birth
5. Social Security Number
or DACA # or Not Applicable [ ]
7. Permanent Mailing Address
8. City
9. State
10. Zip Code
11. Phone Number
12. Email Address
Alternate Email:
13. What will your high school completion status be when
you begin college in the 2019-2020 school year?
High school diploma
[ ]
Homeschooled
[ ]
(Skip to Question 16)
General Educational Development (GED) certificate
[ ]
None of the above
[ ]
(Skip to Question 16) (Skip to question 18)
14. High School Name
(If applicable)
15. High School City
(If applicable)
16. State
(If applicable)
17. Date of
Graduation
(HS or GED)
(If applicable)
18. Will you have your first bachelor’s degree before you begin the 2019-20 school year?
[ ]
Yes
[ ]
No
19. What will your college grade level be when you begin the 2019-20
school year?
20. What degree or certificate will you be working on when you begin
the 2019-20 school year?
Never attended college ……………………………………………………………………………………….
(No college credits)
1st year undergraduate ……………………………………………………………………………
….
(Up to 30 college credits towards degree)
2nd year undergraduate/sophomore ………………………………………………………
….
(30-60 college credits towards degree)
3rd year undergraduate/junior ……………………………………………………..…….…..
(60-90 college credits towards degree)
4th year undergraduate/senior ……………………………………………………………….
(90-120 college credits towards degree)
5th year/other undergraduate ………………………………………………………………..
(120 or more college credits towards degree)
1st year graduate/professional …………………………………………………….…………
Continuing graduate/professional or beyond ……………………………….………
……
1st bachelor’s degree ………………………………….……………………………………………
…
2nd bachelor’s degree …………………………………………………………………….………
….
Associate degree ……………………………………………………………………….……………….
(occupational, technical program, general education or transfer program)
Certificate or diploma …………………………………………………………………….……….
Teaching credential ………………………………………………………………………….…….
(non-degree program)
Graduate or professional degree ……………………………………………………………….
Other/undecided ……………………………………………………………………………………..
2019-20 TASFA
T
exas Application for State Financial Aid July 1, 2019 – June 30, 2020
2019-20 Texas Application for State Financial Aid (TASFA) Page 1
-
STUDENT INFORMATION CONTINUED… (See Notes for questions 24-29)
21. Where do you plan to live during the 2019-20 school year?
On-campus -campus With parent or relative
[ ] [ ]
Off
[ ]
22. At the start of the 2019–20 school year, how many credits/hours will
you be enrolled in?
Full-time (12 hours or more) Three-quarter time (9-11 hours)
[ ] [ ]
Half-time (6-8 hours) Less than half-time (5 hours or less)
[ ] [ ]
Not sure
[ ]
23. If you are transferring schools, have you earned an
Associate Degree?
Yes
[ ]
(Enter the date you earned an Associate Degree _________________)
No
[ ]
24. Were you born male or female?
Male
[ ]
Female
[ ]
In order to qualify for state aid, individuals who were born male must be
registerd for Selective Service or be exempt. A Selective Service statement
and supporting documentation will be collected by your institution to
confirm your status.
25. Have you been convicted of a felony or a crime involving a controlled
substance?
Yes No
[ ] [ ]
26. Have you previously received state Financial Aid?
Yes No
[ ] [ ]
27. (A) Are you interested in being considered for the Texas College
Work-Study program?
Yes Don’t know
[ ] [ ]
No
[ ]
(B) If yes, do you have authorization to work in the U.S.?
[ ]
Yes No Don’t know Not applicable
[ ] [ ] [ ]
28. As of today, what is your marital status?
I am single I am separated
[ ] [ ]
am married/remarried I am divorced or widowed
[ ] I [ ]
29. Month and year you were married, remarried, separated, divorced or
widowed.
Month:
_________
Year:
_____________
Not applicable
[ ]
-
STEP TWO: STUDENT DEPENDENCY STATUS DETERMINATION (See Notes for questions 30 and 35-40)
30. Were you born before January 1, 1996? ......................................................................................................................................
31. As of today, are you married? (Also answer Yes if you are separated but not divorced) ……………………………………………………………………
32. At the beginning of the 2019-20 school year, will you be working on a master’s or doctorate program? ...................................
(e.g. MA, MBA, JD, PhD, EdD, MD, graduate certificate, etc.)
33. Do you now have or will you have children who will receive more than half of their support from you between July 1, 2019 and
June 30, 2020?.........................................................................................................................................................................
34. Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their
support from you, now and through June 30, 2020?.....................................................................................................................
35. At any time since you turned age 13, were you in foster care, were you a dependent or ward of the court, or were both your
parent(s) deceased? (You do not have to currently be a ward of the court)……………………………………………………………………………………...
36. As determined by the state’s court, are you or were you an emancipated minor? ......................................................................
37. As determined by the state’s court, does someone other than your parent or stepparent have legal guardianship of you?......
38. At any time on or after July 1, 2018, did your high school or school district’s homeless liaison determine that you were an
unaccompanied youth who was homeless or were self-supporting and at risk of being homeless?..............................................
39. At any time on or after July 1, 2018, did the director of an emergency shelter or transitional housing program, funded by the
U.S. Department of Housing and Urban Development, determine that you were an unaccompanied youth who was homeless or
were self-supporting and at risk of being homeless?................................................................................................
40. At any time on or after July 1, 2018, did the director of a runaway or homeless youth basic center or transitional living program
determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being
homeless?.....................................................................................................................................................................................
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
Yes No
☐ ☐
2019-20 Texas Application for State Financial Aid (TASFA) Page 2
-
STEP THREE: PARENT INFORMATION (See Notes for questions 41-56)
STOP: If you answered “Yes” to any of the questions in STEP TWO, parental information is not required. Proceed to STEP FOUR.
If you answered “No” to all the questions in STEP TWO, you must include parental information, even if you do not live with your legal parents (biological,
adoptive, or as determined by the state [for example, if the parent is listed on the birth certificate]). Grandparents, foster parents, legal guardians,
widowed stepparents, aunts, uncles, and siblings are not considered parents on this form, unless they have legally adopted you.
If your legal parents are married to each other, or are not married to each other and live together, answer the questions about both of them. If you are in
a single parent home (e.g. parent(s) was never married or is remarried, divorced, separated, etc.), review the TASFA Notes for further clarification.
PARENT’S MARITAL STATUS
41. As of today, what is the marital status of your legal parents?
[ ]
Married or Remarried
[ ]
Never Married
[ ]
Divorced or Separated
[ ]
Widowed
[ ]
Unmarried and both parents living together
42. Month and year your parents were married, remarried, separated,
divorced or widowed:
Month
:_________
Year:_
____________
Not applicable
[ ]
PARENT 1 (Mother/Father/Stepparent)
43. Last Name
44. First Name
45. Date of Birth
46. Social Security Number
or DACA # or Not Applicable [ ]
47. Phone
Number
48. Email Address
49. Highest level of education completed.
[ ]
Middle School/Jr. High
[ ]
High School
[ ] C
ollege or Beyond
[ ]
Other/Unknown
PARENT 2 (Mother/Father/Stepparent)
50. Last Name
51. First Name
52. Date of Birth
53. Social Security Number
or DACA # or Not Applicable
[ ]
54. Phone
Number
55. Email Address
56. Highest level of education completed.
[ ]
Middle School/Jr. High
[ ]
High School
[ ] C
ollege or Beyond
[ ]
Other/Unknown
-
STEP FOUR: INCOME INFORMATION (See Notes for questions 57-66)
STOP: If you answered “Yes” to any of the questions in STEP TWO, parental information is not required. You are only required to enter income
information for yourself (and your spouse).
If you answered “No” to all of the questions in STEP TWO, you must include parental information, as defined in STEP THREE.
PART A. EARNINGS - Documentation will need to be submitted to the financial aid office. (e.g. W-2’s, tax transcripts, tax returns, etc.)
Student Earnings
Parent Earnings
57. Did you (or spouse) work in 2017?
[ ]
Yes
[ ]
No
58. If yes, how much did you (and spouse) earn from working in 2017?
Student: ____________
_____
Spouse:____________________
59. Did you (or spouse) file a 2017 tax return?
Student
[ ]
[ ]
Yes
[ ]
[ ]
No
Spouse Yes No
60. Was an Individual Taxpayer Identification Number (ITIN) used
to file a 2017 tax return? If so, enter below or mark N/A.
Student:_________________
[ ]
[ ]
N/A
Spouse:_________________ N/A
61. As of today, are you (or spouse) a dislocated worker (currently un-
employed)?
Student
[
Yes
]
[ ]
[
No
]
[ ]
[ ]
[ ]
Don’t know
Spouse Yes No Don’t know
62. Did your parent(s) work in 2017?
[ ]
Yes
[
No
]
63. If yes, how much did your parent(s) earn from working in 2017?
Parent 1: _______________ Parent 2:__________________
64. Did your parent(s) file a 2017 tax return?
Parent 1
Yes
[ ]
[ ]
[ ]
[ ]
No
Parent 2 Yes No
65. Was an Individual Taxpayer Identification Number (ITIN) used to file
a 2017 tax return? If so, enter below or mark N/A.
Parent 1:_________________
[ ]
[ ]
N/A
Parent 2:_________________ N/A
66. As of today, is either parent a dislocated worker (currently un-
employed)?
Parent 1
[ ]
[ ]
Yes
[
No
]
[ ]
[
Don’t know
]
[ ]
Parent 2 Yes No Don’t know
2019-20 Texas Application for State Financial Aid (TASFA) Page 3
For questions, 67-71, if the answer is zero or the question does not
apply to you, enter “0” DO NOT LEAVE ANY BLANKS. Report whole
dollar yearly amounts with no cents.
STUDENT
SPOUSE
(If applicable)
PARENT 1
PARENT 2
(If applicable)
PART B. 2017 UNTAXED INCOME (See Notes for questions 67-70)
67. Child support received for any of your children.
68. Housing, food, and other living allowances paid on your behalf.
69. Other untaxed income not reported.
(Such as worker’s compensation, disability, veterans non-education benefits, etc.)
70. Cash earnings. (Wages not listed on taxes or W-2 forms)
71. TOTAL UNTAXED INCOME
PART C. 2017 ADDITIONAL FINANCIAL INFORMATION (See Notes for questions 72-74)
72. Child support paid.
73. Taxable earnings from work-study or other need-based work programs.
74. Earnings from work under a cooperative education program offered by a
college.
PART D. 2017 ASSETS (See Notes for questions 75-77)
75. As of today, what is your total current balance of cash, savings, and
checking accounts?
76. As of today, what is your net worth of investments, including real
estate?
(Do not include the home you live in or the balance of retirement plans)
77. As of today, what is your net worth of current businesses and/or
investment farms?
PART E. FEDERAL ASSISTANCE PROGRAMS
78. At any time during 2017 or 2018, did you (your spouse) or your parents, anyone in your household, or your parent’s household receive benefits from
any of the federal programs listed?
Mark all that apply (leave blank if not applicable).
[ ]
Medicaid or
Supplemental Security
Income (SSI)
[ ]
Supplemental
Nutrition Assistance
Program (SNAP)
[ ] F
ree or
Reduced Price
School Lunch
[ ] T
emporary Assistance
for Needy Families (TANF)
[ ]
Special Supplemental Nutrition
Program for Women, Infants, and
Children (WIC)
PART F. NON-TAX FILERS - Only complete if you (and your spouse) did not file taxes for 2017, or your parent(s) did not file taxes for 2017, if
parental information is required.
79. Explain what sources of income or public assistance you and/or your family used to pay for living expenses. Your financial aid office may request
additional information. (If you (your spouse) and/or your parents did not meet either of the IRS Income filing thresholds from earnings or self-
employment, and did not file taxes, please provide a breakdown of your living expenses (e.g. rent, food, utilities, bills, etc.).
Living Expenses
Cost for the year
To pay for living expenses listed, the following sources of income were used:
Rent
$
Food
$
$
$
$
$
$
2019-20 Texas Application for State Financial Aid (TASFA) Page 4
$ 0.00
$ 0.00
STEP FIVE: HOUSEHOLD INFORMATION (See Notes for questions 80-81)
If you answered “Yes” to any of the questions in STEP TWO, list the people in your household in the chart below. Include yourself (and spouse) and your
children if you will provide more than half of their support between July 1, 2019 and June 30, 2020 (even if they do not live with you). Do not include
people that you will not provide more than half of their support between July 1, 2019 and June 30, 2020 (e.g. a roommate). Include any other people if
they now live with you, and you provide and will continue to provide more than half of their support between July 1, 2019 and June 30, 2020.
If you answered “No” to all of the questions in STEP TWO, list the people in your household in the chart below. Include yourself (even if you don’t live
with your parents), your parents and your parents’ other children (even if they do not live with your parents) if your parents will provide more than half of
their support from July 1, 2019 and June 30, 2020. Include any other people if they now live with your parents, and your parents provide and will continue
to provide more than half of their support between July 1, 2019 and June 30, 2020.
Full Name of each household member
(Examples: parent(s), sibling(s), grandparent or spouse)
Age
Relationship to student
(e.g. sister, son)
College/University
(If attending July 1, 2019 – June 30, 2020)
Self
80. Total number in household:
81. Total number in college for 2019–20:
STEP SIX: SIGNATURE(S) - Application must contain electronic or wet (physical) signature(s) only.
82. I certify that I will use state student financial aid to pay only the cost of attending an institution of higher education, and that the information provided
on this form is true, complete, and correct to the best of my knowledge. I understand that any false statements may void my eligibility for state financial
aid. I also understand that the information provided on this form will be used only for evaluation of eligibility for state (or institutional) financial aid and
that I may need to provide additional information for my school to determine eligibility.
Student Signature Date
Parent Signature* Date
*Only required if all questions in STEP TWO were answered “No”
Mark which parent signed above.
Parent 1
[ ]
Parent 2
[ ]
2019-20 Texas Application for State Financial Aid (TASFA) Page 5
click to sign
signature
click to edit
click to sign
signature
click to edit
Financial Aid Office
2019 – 2020 SB1528 STATEMENT
Student Information
Name: CWID:
To qualify for Texas SB 1528, the student is required to complete the following:
…if the person (student) is not a citizen or permanent resident of the United States, (sign) an affidavit
stating that the person will apply to become a permanent resident of the United States as soon as the
person becomes eligible to apply. Per Texas Education Code Title 3, Subtitle A, Chapter 54, Subchapter
A, Sec 54.053. (3)(B)
I, , affirm that I will file an application to become a
(Student’s printed name)
permanent resident at the earliest opportunity to do so.
Student signature Date
Contact Us:
P:
(972)881-5760
Financialaid@collin.edu
Office use only:
Aid Year
:______
Campus
:______
Date
:__________
RRAAREQ
Code
: SB1528
Status Code
:_______
Initials
:_______
click to sign
signature
click to edit
Contact Us:
Financial Aid Office P: (972) 881-5760
Financialaid@collin.edu
2019 – 2020 DEPENDENT VERIFICATION WORKSHEET
Student Information
Name:
CWID:
Your application has been selected by the Dept. of Education for review in a process called “Verification.” In this process, we
are required by federal law (34 CFR, Part 668) to compare information from your Free Application for Federal Student Aid
(FAFSA) with information from you (and your spouse if you are married) and your parent(s)’/stepparents’ (if you
are
dependent)
2017 federal tax transcripts and/or other financial documents. If there are any discrepancies, we may request
further clarification. If corrections are needed, we will make them on your behalf and notify you of the change. It is important
that you respond promptly to this request. We cannot award you financial aid until your file is complete.
Dependent Student’s Family Information
List below the people in your parent(s)’ household. Include:
• Yourself and your parent(s) (including a stepparent) even if you don’t live with your parent(s).
• Your parent(s)’ other children if your parent(s) will provide more than half of their support from July 1,
2019, through June 30, 2020, or if the other children would be required to provide parental information if
they were completing a FAFSA for 2019–2020. Include children who meet either of these standards, even if
they do not live with your parent(s).
•
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support
and
will continue to provide more than half of their support through June 30, 2020.
Include the name of the college for any household member, excluding your parents, who will be enrolled at least half
time, in a degree, diploma, or certificate program at a Title IV eligible postsecondary educational institution any time
between July 1, 2019, and June 30, 2020. If more space is needed, attach a separate page with your name and Student ID Number
at the top.
Full Name
Age
Relationship
College
Will be Enrolled at
Least Half Time
Marty Jones(example)
28
Wife
Central University
Yes
Self
Office use only:
Aid Year:______ Campus:______ Date:__________ RRAAREQ Code: DVST17 Status Code:_______ Initials:_______
Student’s
Name:
CWID:
Income Information to Be Verified
1. Student Information:
A. TAX RETURN FILERS - Check one of the following:
I, the student, certify that I have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my 2017
IRS income information into my FAFSA, either on the initial FAFSA or when making a correction to the
FAFSA. I
also certify that I DID NOT MAKE CHANGES to any of the data once it was transferred.
Your Financial Aid Advisor will verify that you a) used the IRS Data Retrieval Tool in FAFSA and b) made NO CHANGES
to the data once it was transferred. If they can confirm both items, they will use the IRS information that was transferred. However,
if the Financial Aid Advisor cannot confirm one or both of the above, you will be required to submit a 2017 tax transcript.
I, the student, was unable or chose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and am
submitting to the school my 2017 IRS Tax Return Transcript(s)—NOT photocopies of the income tax return.
To obtain an IRS Tax Return Transcript, go to www.IRS.gov and click on the “Get Transcript” link, or call 1-800-908-9946.
Make sure to request the “IRS Tax
Return Transcript
”
and not the “IRS Tax Account Transcript.” You will need your
Social Security Number, date of birth, and the address on file with the IRS (normally this will be the address used when the 2017
IRS tax return was filed). It takes up 2 - 3 weeks for IRS income information to be available for electronic IRS tax return filers,
and 8 – 11 weeks for paper IRS tax return filers.
If you filed an amended tax return, you will need to submit an “IRS Tax
Return Transcript
”
and a signed copy of the 1040X.
B. TAX RETURN
NON-FILERS
– Complete
this section if you, the student, will not file and are not required to
file a 2017 income tax return with the IRS. If you fall into either category below, you MUST provide a
Verification of Non-Filing Letter from the IRS with this form.
Check the box that applies:
I, the student, was not employed and had no income earned from work in 2017.
I, the student, was employed in 2017 and have listed below the names of all employers and the amount earned
from each employer in 2017. Attach copies of all 2017 W-2 forms issued to you by employers
. If more space is
needed, attach a separate page with your name and CWID at the top.
Employer’s Name
2017 Amount Earned
Suzy’s Auto Body Shop (example)
$2,000.00
Please note: Per federal regulations, we can no longer accept copies of the filed federal tax returns (i.e., 1040, 1040A
or 1040EZ). You are required to submit a 2017 Federal Tax Return Transcript. Instructions for obtaining a tax transcript
can be found above. Please make copies of the tax transcript for your own records PRIOR to submitting the verification
paperwork to our office.
Student’s
Name:
CWID:
2. Parent Information:
A. TAX RETURN FILERS
- Check one of the following:
I, the student’s parent, certify that I have used the IRS Data Retrieval Tool in FAFSA on the Web to transfer my
(and, if married, my spouse’s) 2017 IRS income information into my FAFSA, either on the initial FAFSA or when
making a correction to the FAFSA. I also certify that I DID NOT MAKE CHANGES to any of the data once it
was transferred.
The Financial Aid Advisor will verify that you a) used the IRS Data Retrieval Tool in FAFSA and b) made NO CHANGES to
the data once it was transferred. If they can confirm both items, they will use the IRS information that was transferred. However, if the
Financial Aid Advisor cannot confirm one or both of the above, you will be required to submit a 2017 tax transcript.
I, the student’s parent, was unable or chose not to use the IRS Data Retrieval Tool in FAFSA on the Web, and
am submitting to the school my (and my spouse’s if married) 2017 IRS tax return transcript(s)—NOT
photocopies of the income tax return.
To obtain an IRS tax return transcript, go to www.IRS.gov and click on the “Get Transcript” link, or call 1-800-908-9946.
Make sure to request the “IRS Tax
Return Transcript
”
and not the “IRS Tax Account Transcript.” See the student’s section
on page 2 for more ordering information.
If you filed an amended tax return, you will need to submit an “IRS Tax
Return Transcript
”
and a signed copy of the 1040X.
B. TAX RETURN
NON-FILERS
—Complete
this section if you, the student’s parent(s), will not file and are not
required to file a 2017 income tax return with the IRS. If you fall into either category below, you MUST provide
a Verification of Non-Filing Letter from the IRS with this form.
Check the box that applies:
I, the student’s parent, (and/or, if married, your spouse) was not employed and had no income earned from
work in 2017.
I, the student’s parent, (and/or, if married, your spouse) was employed in 2017 and have listed below the names
of all employers and the amount earned from each employer in 2017. Attach copies of all 2017 W-2 forms issued
to you (and, if married, to your spouse) by employers. If more space is needed, attach a separate page with your name and
CWID at the top.
Employer’s Name
2017 Amount Earned
Suzy’s Auto Body Shop (example)
$2,000.00
3. Other Information to Be Verified
1. Both the student and the parent need to complete the chart on the next page. Please put $0’s in any space where the
answer is $0. Do not leave blank
.
Student’s
Name:
CWID:
Student
2017 ADDITIONAL FINANCIAL INFORMATION
Parent(s)
$
Taxable earnings from need-based employment programs such as Federal Work-Study and need-based
employment portions of fellowships and assistantships.
$
$
Grant and scholarship aid reported to the IRS in the adjusted gross income. Includes AmeriCorps benefits
(awards, living allowances, and interest accrual payments), as well as grant and scholarship portions of
fellowships and assistantships.
$
$
Combat pay or special combat pay. Only enter the amount that was taxable and included in the adjusted
gross income. Do not enter untaxed combat pay reported on the W-2 (Box 12, Code Q).
$
$ Earnings from work under a Cooperative Education Program offered by a college. $
Student
2017 UNTAXED INCOME
Parent(s)
$
Payments to tax-deferred pension and savings plans (paid directly or withheld from earnings) including, but
not limited to, amounts reported on the W-2 Form (Boxes 12a through 12d, codes D, E, F, G, H, and S).
$
$
Child support you received for all children. Do not include foster care or adoption payments.
$
$
Housing, food and other living allowances paid to members of the military, clergy, and others (including
cash payments and cash value of benefits). Do not include the value of on-base military housing or the
value of a basic military allowance for housing.
$
$
Veterans’ non-education benefits such as Disability, Death Pension, or Dependency & Indemnity
Compensation (DIC) and/or VA Educational Work-Study allowances.
$
$
Other untaxed income not reported, such as worker's compensation, disability, Black Lung Benefits,
untaxed portions of health savings accounts from IRS Form 1040 Line 25, Railroad Retirement Benefits,
etc. DO NOT INCLUDE: student aid, earned income credit, additional child tax credit, TANF payments,
untaxed Social Security benefits, Supplemental Security Income (SSI), Workforce Investment Act
educational benefits, combat pay, benefits from flexible spending arrangements (e.g. cafeteria plans),
foreign income exclusion, or credit for federal tax on special fuels.
$
$
Money received, or paid on your behalf (e.g., bills), not reported elsewhere on this form.
XXXXXXXX
Certification and Signatures
By signing this worksheet, I (we) certify that all information reported on this worksheet is complete and correct. If dependent, at least one parent
must sign. Warning: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student’s Signature Date
Parent’s Signature Date
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TASFA (Texas Application for State Financial Aid) Check (Collin County Community College District)

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Completed 6 October 2020

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